Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation

Patient portals allowing access to electronic health care records and services can inform and empower but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care. A retrospective single site cross-sectional study was undertaken to examine patient portal adoption amongst families of children receiving care for chronic or complex disorders within the United Kingdom. Descriptive and multivariable regression analysis was undertaken to describe associations between predictors (Race/Ethnicity, age, socio-economic deprivation status based on family residence, and previous non-attendance to outpatient consultations) and outcome. A sample of 3687 children, representative of the diverse ‘real world’ patient population, was identified. Of these 37% (1364) were from a White British background, 71% (2631) had English as the primary family spoken language (PSL), 14% (532) lived in areas of high deprivation, and 17% (643) had high (>33%) rates of non-attendance. The families of 73% (2682) had activated the portal. In adjusted analyses, English as a PSL (adjusted odds ratio [aOR] 1.58, 95% confidence interval 1.29–1.95) and multi-morbidity (aOR 1.26, 1.22–1.30) was positively associated with portal activation, whilst families from British Black African backgrounds (aOR 0.68, 0.50–0.93), and those with high rates of non-attendance (aOR 0.48, 0.40–0.58) were less likely to use the portal. Family race/ethnicity and previous low engagement with health care services are potentially key drivers of widening inequity in access to health care following the implementation of patient portals, a digital health innovation intended to inform and empower. Health care providers should be aware that innovative human-driven engagement approaches, targeted towards previously underserved communities, are needed to ensure equitable access to high quality patient-centred care.Author summary: From a retrospective cross-sectional study of 3687 children with complex health disorders within a specialist paediatric care centre, the families of 73% had adopted an electronic patient portal within 2.5 years of portal launch. Family ethnic backgrounds and previous poor engagement with health care services were independently associated with lower odds of family adoption. There was evidence of a potential differential impact of socioeconomic deprivation and spoken language across different ethnic groups. We suggest that equitable uptake of digital health services by children’s families requires health care providers to implement engagement approaches developed in partnership with underserved communities. However, those underserved communities should also have access to alternative patient centred communication pathways to ensure true inclusion in health care provision. Care providers must be particularly careful to offer these alternative pathways to families who have struggled to interact with healthcare in the past.